I don’t get how therapy works!

I received a message from one of the members of my practice Facebook community, sharing that she had tried several medications and has been in therapy for years for depression, but nothing seemed to help. She said, “I really don’t get how therapy works!”

If you have never been to therapy before and are wondering about whether to give therapy a chance or not, it is likely that you have had similar questions in your mind.

Many people, think of therapy as a place where we go to get advice, or to talk about what bothers us. Thankfully nowadays, not as many people seem to be thinking of therapy as something for “crazy” people.

Therapy is surrounded by an atmosphere of mystery mostly due to issues related to stigma. People tend to not talk very freely about seeing a therapist, and therapists go to great extents to protect client’s confidentiality if they are engaging in outside conversations about their work.

Usually, the work of therapy is only discussed among professionals in the field. As a result, the general public has not been included in the conversations about their psyche and about the treatments available to them to alleviate their emotional suffering.

Luckily you do not need to know how therapy works for you to benefit from it! But there are a few “rules” or “principles” that can help you get more from your therapy if you keep them in mind.

You’re therapist is not THE expert. The only person who really knows YOU, is YOU. Therapists do not have the power, or the right, to tell you if something is a problem if you do not think it is a problem. If you are thinking of going to therapy because what you are thinking, feeling, or behaving, is a problem in SOMEONE ELSE’S OPINION, then you are not likely to benefit from therapy. You are the only person who can say if you have a problem or not. This is also important but difficult for family members to fully understand. I frequently get phone calls from people who are worried about a loved one and would like that person to be in therapy. I completely understand how painful it is to see our loved ones suffering or sabotaging themselves, but there is really nothing we can do to help someone who does not want help, or does not see the need for change.

If you are not willing to talk about an INTERNAL EMOTIONAL PROBLEM then it is not likely that therapy can help you. Or it might take you a long time to get the benefits. For some reason, some people want to come to therapy to talk about others (their children, their spouses, their parents), or about a non-psychological problems. Sometimes, people need to warm up to talk about the “real issue” that is bringing them to seek help. However, the more time you spend talking in therapy about “non-problems,” the more likely is that you will grow hopeless or frustrated in your therapy. Therapy is a very considerable investment of time, energy, and money; make sure that you come ready to do the work! A good therapist will challenge you to face what you went to therapy to face, instead of letting you ramble for weeks, month, or years. One exception, psychoanalysis. The task in psychoanalysis is very different (clients are asked to talk about anything that comes to their minds). But psychoanalysis is a long-term therapeutic process. If you are hoping for a more time-effective process, then specificity and focus is a more helpful approach.

50-minute once a week of work on yourself won’t get you too far. It is not likely that going to the therapist once a week, for 50 minutes is going to help you overcome your problems if you are not willing to practice outside what you learn in therapy. The therapist does not have to give you homework for you to try to practice or pay attention to the decisions you make in your real life once you leave your therapist office. I usually ask my patients at the end of their sessions about what they learn in the session, or ask them to summarize their insights, so that they can be clear about the important aspects that they will be paying attention to once they are on their own. If at the end of the session you are confused and you are not sure about your insights, ask your therapist for clarification. If you are confused at the end of the session, it can also mean that you and your therapist will need to slow things down a bit, and perhaps pay more attention to your anxiety so that your cognitive abilities are fully available to you.

You don’t want to talk about something difficult, you don’t have to. Only you can decide what to share with your therapist. However, bear in mind that your therapist can only help you with those things you share. Therapists are not mind readers. If you find yourself withholding or hesitating, it is probably a good idea that you share with your therapist your concerns about sharing. It is very common, that people hold back when they are themselves holding some judgment about their feelings, thoughts, or behaviors. A good therapist should be able to address your concerns so that you can make a decision that supports you in the work that you are doing in therapy.

Be willing to offer feedback to your therapist. If you are working hard on your goals, and you are not seeing improvement or progress, have an honest conversation with your therapist. Ask your therapist about how they see your progress as well. Sometimes it is hard to objectively notice improvement and deterioration in patients. Some clinicians have begun to use objective outcome measures that can alert them if a patient is worsening so that adjustments can be made promptly. Many people leave therapy prematurely because they do not see improvement. Before concluding that therapy is not helpful for you, be sure to discuss your concerns with your therapist.

As a client, you have the right and the duty to take your share of responsibility to make therapy work for yourself. It is the work of the two-people involved in a therapy process, each giving their 100%, that can make therapy effective. If you are not seeing the progress you wish to see in your therapy, check to see if you are not following one of these rules, and see if making the suggested changes can help you move forward with your therapy goals.